The Ebola crisis, WHO and missing funds to fight the epidemic

For the first time in 2015, WHO is reporting an increase in Ebola cases in Guinea, Liberia and Sierra Leone, with 124 cases this week alone. There have been a total of 22,495 people infected with the disease since it started, with 8,981 deaths.

With the Ebola epidemic dragging on, scientists, including Lucas Valdez from the National University of Mar del Plata in Argentina are now saying that new projection models show the epidemic ending in May of this year. But the problem with this latest report is that the researchers could only use data gathered from Liberia, the only country out of the three worst-hit that kept good medical information.

But the epidemic is facing serious challenges, in funding and in the deployment of resources to fight the virus and treat patients. This loggerhead of problems has created a headache for the World Health Organization's Director-General Margaret Chan, MD. She told reporters in late January that "The West African epidemic is a "mega-crisis (that) overwhelmed the capacity of WHO."

Dr. Chan fears that WHO will lose its credibility with the world's nations as a bulwark against infectious disease if reforms are not made now in the structure of the organization. She said this would also include having a large contingency fund in place for emergencies, as well as an increased number of trained people to deploy to nations in an emergency.

Lawrence Gostin, JD, of the O'Neill Institute for National and Global Health Law at Washington's Georgetown University thinks making fundamental changes in WHO's structure could be a pivotal decision, and "if the opportunity for reform is missed," Gostin told MedPage. "WHO will have lost the confidence of the world for a generation."

Reforms, preparedness, and infrastructure

While it is true that WHO was not prepared for the onslaught of Ebola cases we have seen, there are other factors at play. When the epidemic started in December 2013 in a remote jungle area of Guinea, it was three months before anyone paid any attention, and by that time, Ebola had its grasp on that nation. WHO was under-prepared for the epidemic, and even worse, Guinea was, and is a country with an almost nonexistent health care system, as is Sierra Leone and Liberia.

According to Gostin, member nations of WHO are obliged to build up their own infrastructures and those of their less fortunate neighbors. It is an expensive and long-term obligation, and Gostin says the latest reform proposals don't have plans for sustainable funding to meet these obligations. Amesh Adalja, MD, of the Center for Health Security at the University of Pittsburgh Medical Center said in this latest Ebola outbreak, WHO saw itself as a "big brother, handing out technical assistance." But, Adalja said, "you can't give technical assistance when there's no infrastructure to assist."

Funding and misuse of funds has been a serious problem

Karen Grépin, assistant professor of global health policy at New York University released a report on the global monetary response to the Ebola crisis, and it is not pretty. The study, released on Tuesday reported that of the $3.0 billion pledged by countries around the world, only $1.0 billion has been paid out.

NBC News reported that Grepin wrote in her report, published in the British Medical Journal, that "The problem has not been the generosity of donors but that the resources have not been deployed rapidly enough. The international response has been called both too small and too slow, and this may have contributed to the ongoing spread of the disease."

Added to the slowness of international funding getting to where it is needed most is the misuse and misappropriation of funds in Sierra Leone, one of the hardest hit of the West African countries. Sierra Leone's national auditor says authorities have "lost track" of almost one-third of 84 billion leones ($19.5 million or 16.9 million euros) that had been set aside by the government last May, and again in October.

The audit showed that most of the money was spent on personal protective equipment, medical supplies, consumables and bonus payments to health care workers. There was no paperwork to support the spending of 14 billion leones ($3.2 million, 2.8 million euros). An additional 11 billion leones from the same account had missing receipts and invoices.

Most of the money in this account, a government emergency health response account, came from taxes and donations from domestic institutions and individuals. It does not include money from UN agencies or international non-governmental organizations. Even worse, earlier this past week, authorities said they were cleaning up a list that contains "thousands of ghost workers" on its Ebola staff.

"Monies that have been set aside for the purpose of combating the Ebola outbreak may have been used for unintended purposes, thereby slowing the government's response to eradicate the virus," said the auditor's report, presented to parliament on Friday. On Friday, Sierra Leone placed hundreds of homes on lock-down in the capital, Freetown after experiencing a spike in the number of Ebola cases.